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    Distal Loopogram

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    khushi786
    This document describes a loopogram performed on a 68-year-old male with a history of bladder cancer and ileal conduit urinary diversion. The loopogram showed normal findings in the right ureter and ileal conduit but no contrast entered the left ureter, indicating an obstruction. Differential diagnoses for the left ureteral obstruction include improperly fashioned anastomosis, ischemia, recurrent tumor, or adhesions. Suggested next steps are renal ultrasound, radionuclide studies, or CT to further evaluate the left renal collecting system and cause of obstruction.

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    Distal Loopogram

    Uploaded by

    khushi786
    3K views17 pages
    This document describes a loopogram performed on a 68-year-old male with a history of bladder cancer and ileal conduit urinary diversion. The loopogram showed normal findings in the right ureter and ileal conduit but no contrast entered the left ureter, indicating an obstruction. Differential diagnoses for the left ureteral obstruction include improperly fashioned anastomosis, ischemia, recurrent tumor, or adhesions. Suggested next steps are renal ultrasound, radionuclide studies, or CT to further evaluate the left renal collecting system and cause of obstruction.

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    Distal Loop-o-gram

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    This document describes a loopogram performed on a 68-year-old male with a history of bladder cancer and ileal conduit urinary diversion. The loopogram showed normal findings in the right ureter and ileal conduit but no contrast entered the left ureter, indicating an obstruction. Differential diagnoses for the left ureteral obstruction include improperly fashioned anastomosis, ischemia, recurrent tumor, or adhesions. Suggested next steps are renal ultrasound, radionuclide studies, or CT to further evaluate the left renal collecting system and cause of obstruction.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    3K views17 pages

    Distal Loopogram

    Uploaded by

    khushi786
    This document describes a loopogram performed on a 68-year-old male with a history of bladder cancer and ileal conduit urinary diversion. The loopogram showed normal findings in the right ureter and ileal conduit but no contrast entered the left ureter, indicating an obstruction. Differential diagnoses for the left ureteral obstruction include improperly fashioned anastomosis, ischemia, recurrent tumor, or adhesions. Suggested next steps are renal ultrasound, radionuclide studies, or CT to further evaluate the left renal collecting system and cause of obstruction.

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    You are on page 1of 17

    LOOPOGRAM

    Richard Danieli

    Patient Information

    A 68 year old male with history of muscle


    invading bladder cancer.
    Post operative robotic assisted radical
    cystoprostatectomy
    Post operative ileal conduit urinary
    diversion performed

    Patient History

    History of bladder cancer


    Prior CT
    Filling defects in the dilated left renal pelvis
    Absence of contrast opacification of the left
    ureter,
    Recommend direct inspection of the left
    collecting system with cystoscopy and
    ureteroscopy.
    Interval worsening of the left
    hydroureteronephrosis.
    Anastomotic stricture at the junction between
    the ureter and ileal conduit cannot be
    excluded

    Reason for the


    Examination

    Recommendation from prior CT


    Evaluate Ileal Conduit
    Evaluate left ureter by retrograde
    contrast administration

    Relevant Information

    History of bladder cancer


    Obstructed proximal left ureter seen on
    prior CT

    Radiographic Procedure

    24-gauge Foley catheter inserted into stoma


    with 30 cc balloon inflated
    Conray-60 introduced into ileal conduit by
    gravity infusion
    Reflux into right ureter
    No contrast entered the left ureter despite
    various positional changes and delayed
    imaging.
    Patient vomited possibly due to relative over
    distention of the ileal bladder in attempts to
    induce left ureteral reflux

    Examination Results

    Normal right upper urinary tract


    Normal ileal conduit contour
    No reflux into left ureter due to
    obstruction at the ureteroileal junction

    Loopogram Spot Film AP


    Note: No
    contrast in
    left ureter
    Catheter
    Right ureter

    Catheter
    balloon

    Ileal conduit

    Loopogram Spot Film Slight LPO

    Catheter

    Note: No
    contrast in
    left ureter

    Catheter
    balloon
    Right ureter
    Ileal
    conduit

    Loopogram Spot Film Steep LPO

    Right
    ureter

    Note: No
    contrast in left
    ureter

    Catheter
    balloon
    Catheter

    Ileal
    conduit

    Abdomen/Pelvis CT with IV
    Contrast Coronal Image

    IV contrast
    in right
    ureter

    IV contrast
    remained in
    left renal
    pelvis

    Abdomen/Pelvis CT with IV
    Contrast Axial Image

    IV
    contrast
    in right
    ureter

    IV contrast
    remained
    in left renal
    pelvis

    Differential Diagnosis

    No contrast extravasated therefore obstructed


    Ureteral obstruction post ileal conduit

    Improperly fashioned anastomosis


    Ischemia of the ureter with subsequent fibrosis and
    stricture
    Recurrent tumor in the ureter (rare)
    Infection or abscess formation with reaction
    Edema
    Calculus
    Sloughed papilla
    Adhesions or scarring.
    Torsion or compression at the sigmoid

    Discussion

    No extravasation of contrast outside of


    the ileal conduit or the right ureter
    Normal contour of ileal conduit and right
    ureter
    No contrast filling into the left ureter
    during the loopogram.
    Left ureter not evaluated from retrograde
    contrast administration via loopogram or
    antegrade contrast administration via CT

    Suggestions

    Renal ultrasound
    Renal radionuclide studies,
    Percutaneous nephrogram/ureterogram
    Intravenous pyelogram (IVP)
    Abdomen/pelvis CT (with oral contrast,
    with and without IV contrast)

    Discussion Questions

    John:
    1. Where are post operative ileal conduit obstructions
    most common?
    2. Besides obstruction, what is the other most common
    abnormality post operative ileal conduit surgery.

    Stacy:
    1. Describe pseudoobstruction (conduit malfunction) and
    the cause.
    2. What is a mucus plug in reference to a loopogram?

    Tina:
    1. Describe two renal complications of an ileal conduit.
    2. What risks are associated with an excessive length of
    an ileal conduit?

    References

    Appleby,S.,&Atala,A.(2010,September2).UrostomyandContinentUrinaryDiversion.National
    Kidney and Urologic Diseases Information Clearinghouse.RetrievedJuly7,2012,from
    http://kidney.niddk.nih.gov/kudiseases/pubs/urostomy/index.aspx

    Banner,M.P.,Pollack,H.M.,Bonavita,J.A.,&Ellis,P.S.(1984).Theradiologyofurinary
    diversions.Radiographics,4,885-913.Retrievedfrom
    http://radiographics.rsna.org/content/4/6/885.full.pdf+html?sid=b58c27e0-59a3-40e3-bba6-39316da2f
    87d

    Fernbach,S.,&Holland,E.(1988).Undiversionoftheurinarytract:Thepre-andpostoperatie
    evaluation.Radiographics,8,213-233.Retrievedfrom
    http://radiographics.rsna.org/content/8/2/213.full.pdf+html?sid=b58c27e0-59a3-40e3-bba6-39316da2f
    87d

    Noble,J.,Amin,Z.,Kessel,D.,&Rickards,D.(1994).Recurrentuppertracturothelialtumours:the
    useofloopographyfollowingcystectomyforbladdercancer.British Journal of Radiology,67(803),
    1057-1061.Retrievedfromhttp://www.ncbi.nlm.nih.gov/pubmed/7820396

    Thiruchelvam,N.,Harrison,M.,&Page,A.C.(2007).Thedoublewiretechnique:animproved
    methodfortreatingchallendingureteroilealanastomoticstricturesandocclusions.British Journal of
    Radiology,80,103-106.Retrievedfromhttp://bjr.birjournals.org/content/80/950/103.long

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